ACR70-disease Activity Score Remission Achievement From Switches Between All the Available Biological Agents in Rheumatoid Arthritis: A Systematic Review of the Literature

Arthritis Res Ther. 2009;11(6):R163. doi: 10.1186/ar2848. Epub 2009 Nov 3.

Abstract

Introduction: The aim of our analysis was to compare the gaining of a major response (disease activity score [DAS] remission or American College of Rheumatology 70% improvement criteria [ACR70]) by switching between all the available biological therapies in rheumatoid arthritis.

Methods: A systematic review was performed including studies, published before December 2008, in which a second biological agent was used and clinical outcomes were evaluated after a first biological failure.

Results: Nine articles were included. Switching from etanercept and/or infliximab to adalimumab is effective with an ACR70 response ranging from 5% to 33%. Rituximab may be slightly more effective than switching to a second anti-tumor necrosis factor-alpha (anti-TNFalpha), reaching an ACR70 or DAS remission response in 12% and 9%, respectively. Clinical trials confirmed the efficacy in switching to abatacept (gain of effect 10.2%). Tocilizumab allows DAS28 (DAS using 28 joint counts) remission in 30.1% but ACR70 only in 12.4% of patients refractory to anti-TNFalpha.

Conclusions: The efficacy of a second biological agent, irrespective of the mode of action, in reaching an ACR70 or DAS remission after a first biologic is observed from 5% to 15% and from 9% to 15.4%, respectively (except in two studies).

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Abatacept
  • Adalimumab
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Clinical Trials as Topic
  • Etanercept
  • Humans
  • Immunoconjugates / therapeutic use
  • Immunoglobulin G / therapeutic use
  • Infliximab
  • Receptors, Tumor Necrosis Factor / therapeutic use
  • Remission Induction
  • Rituximab

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Immunoconjugates
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Rituximab
  • Abatacept
  • Infliximab
  • Adalimumab
  • tocilizumab
  • Etanercept